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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 7 of 7 Research Studies DisplayedGreenberg JK, Olsen MA, Johnson GW
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
This study evaluated whether measuring traumatic brain injury size (eg, hematoma size) in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs) improves risk prediction compared with the KIIDS intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model. The cohort included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training and testing cohorts. The generalized linear model (GLM) and recursive partitioning (RP) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity. By comparison, the KIIDS-TBI model had slightly higher sensitivity but lower specificity.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Olsen MA, Johnson GW .
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
Neurosurgery 2022 Jun;90(6):691-99. doi: 10.1227/neu.0000000000001895..
Keywords: Children/Adolescents, Brain Injury, Shared Decision Making
Greenberg JK, Otun A, Kyaw PT
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) is a validated risk prediction model designed to manage children with mild traumatic brain injuries (mTBI) and intracranial injuries. Implementing electronic clinical decision support (CDS) may help integrate this evidence-based guidance into clinical practice. The purpose of this study was to assess the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States participated in usability testing of a novel CDS prototype within a simulated electronic health record environment. The testing involved a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype underwent two updates during testing based on user feedback. Usability issues identified in the videos were categorized using content analysis, while interview transcripts were analyzed using thematic analysis. The study found that of the 20 participants, the majority worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, issues with clarity of terminology and navigation within the CDS interface were identified and resolved. As a result, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3, and the number of errors made dropped from 18 in phase 1 to 2 in phase 3. According to the survey, 90% of participants found the tool easy to use, 95% found the tool useful in determining a patient's level of care, 90% found it likely to improve resource utilization, and 79% found it likely to improve patient safety. Interview themes focused on the CDS's capability to support evidence-based decision-making and enhance clinical workflow, as well as suggested implementation strategies and potential challenges.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Kyaw PT .
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
Appl Clin Inform 2022 Mar; 13(2):456-67. doi: 10.1055/s-0042-1745829..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT)
Greenberg JK, Ahluwalia R, Hill M
Development and external validation of the KIIDS-TBI tool for managing children with mild traumatic brain injury and intracranial injuries.
This study's objectives were to develop a new risk model with improved sensitivity compared to the CHIIDA model for the post-neuroimaging management of children with mild traumatic brain injuries (mTBI) and intracranial injuries and further to validate externally the new model and CHIIDA model in a multicenter data set. Findings showed that the KIIDS-TBI model had high sensitivity and moderate specificity for risk stratifying children with mTBI and intracranial injuries. The researchers concluded that the use of their clinical decision support tool may help improve the safe, resource-efficient management of this important patient population.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Ahluwalia R, Hill M .
Development and external validation of the KIIDS-TBI tool for managing children with mild traumatic brain injury and intracranial injuries.
Acad Emerg Med 2021 Dec;28(12):1409-20. doi: 10.1111/acem.14333..
Keywords: Children/Adolescents, Brain Injury, Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT)
Holding EZ, Turner EM, Hall TA
The association between functional status and health-related quality of life following discharge from the pediatric intensive care unit.
This study investigated the association between new functional impairments, measured by the Functional Status Scale (FSS), and health-related quality of life (HRQOL) in pediatric patients with acquired brain injury (ABI) after critical care. This secondary analysis was conducted using children aged 2 months to 18 years with ABI. Complete data were analyzed for 195 children, including 127 with traumatic brain injury. New functional impairment was common with 32 patients experiencing FSS ≥ 3, 50 (26%) patients with FSS increases of 1-2 points, and 113 (58%) patients with no change from prehospital baseline. The majority of children (63%) demonstrated HRQOL ratings ≥ 1 standard deviation below healthy age-based standards.
AHRQ-funded; HS022981.
Citation: Holding EZ, Turner EM, Hall TA .
The association between functional status and health-related quality of life following discharge from the pediatric intensive care unit.
Neurocrit Care 2021 Oct;35(2):347-57. doi: 10.1007/s12028-021-01271-8..
Keywords: Children/Adolescents, Quality of Life, Brain Injury, Intensive Care Unit (ICU)
Marin JR, Rodean J, Mannix RC
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
The objective of this study was to examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) were associated with lower head computed tomography (CT) use. The investigators concluded that clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Mannix RC .
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
J Pediatr 2021 Aug;235:178-83.e1. doi: 10.1016/j.jpeds.2021.04.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT), Brain Injury, Guidelines, Evidence-Based Practice, Imaging
Bradbury KR, Williams C, Leonard S
Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury.
This study assessed parent-reported emotional functioning in children with traumatic brain injury (TBI) and identified risk factors for emotional sequelae in the acute recovery phase. Results from logistic regression indicated that only elevated parent PTSD symptoms were a significant predictor for child anxiety and depressive symptoms. Anxiety and depressive symptoms were prevalent in the acute recovery phase of TBI. Consistent with previous research, elevations in anxiety and depressive symptoms were more related to psychosocial factors than to injury severity.
AHRQ-funded; HS022981.
Citation: Bradbury KR, Williams C, Leonard S .
Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury.
J Child Adolesc Trauma 2021 Jun;14(2):177-87. doi: 10.1007/s40653-020-00332-y..
Keywords: Children/Adolescents, Brain Injury, Trauma, Neurological Disorders
Greenberg JK, Otun A, Nasraddin A
Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis.
This paper discusses the development of an evidence-based clinical decision support (CDS) for management of children with minor head trauma (MHT) and evaluates the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure. Semi-structured qualitative focus group interviews were conducted with 28 physicians and four information technology specialists between March and May 2020. Five primary themes were identified through inductive thematic analysis: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported CDS use to determine an appropriate level-of-care. However, some had mixed feelings regarding how the tool could best be used by neurosurgeons versus non-neurosurgeons. Feedback helped refine the tool content and highlighted potential technical and workflow barriers to address prior to implementation.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Nasraddin A .
Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis.
BMC Med Inform Decis Mak 2021 May 19;21(1):161. doi: 10.1186/s12911-021-01522-w.
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Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT), Evidence-Based Practice, Shared Decision Making